Healthcare Provider Details

I. General information

NPI: 1619345022
Provider Name (Legal Business Name): EVELYN PLUMB PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 INDIAN SCHOOL RD NE STE 143
ALBUQUERQUE NM
87110-3176
US

IV. Provider business mailing address

PO BOX 1085
TAOS NM
87571-1085
US

V. Phone/Fax

Practice location:
  • Phone: 505-542-4970
  • Fax: 505-213-6301
Mailing address:
  • Phone: 707-367-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1620
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: